Imperial Manor of Hazel Crest, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0040402 Issued in IL

Legal business name

IMPERIAL MANOR OF HAZEL CREST, LLC

Practice address

3300 175TH St
Hazel Crest, IL 60429-1604

Phone

(708) 335-2400

Fax

(708) 335-1825

NPI assigned

Aug 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Steinberg

Title

Chief Operating Officer

Phone

(847) 905-3000

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1902098239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 175TH ST",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291604",
            "telephone_number": "708-335-2400",
            "fax_number": "708-335-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 175TH ST",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291604",
            "telephone_number": "708-335-2400",
            "fax_number": "708-335-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL MANOR OF HAZEL CREST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "STEINBERG",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "847-905-3000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0040402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.